Central shunt procedures for complex congenital heart diseases.

ABSTRACT

OBJECTIVE: The study was designed to analyze the results of central shunt procedure using Gore-Tex grafts for treatment of patients with complex congenital heart diseases. METHODS: A Gore-Tex graft was implanted using an end-to-side anastomosis technique connecting the aorta with the pulmonary artery. The graft size was determined based on the patients' body weight. Artery growth and percutaneous plasma oxygen were examined pre- and postoperatively. RESULTS: The procedure was performed without cardiopulmonary bypass in 96 of 110 cases. Shunt sizes from 3.5 to 6.0 mm were employed. After operation, the oxygen saturations increased significantly from 65.2% ± 7.3 to 84.1% ± 3.8 (p < 0.05). Both left and right pulmonary arteries were found to grow significantly in size, from 4.9 ± 1.8 to 7.5 ± 2.0 mm and from 6.1 ± 2.3 to 8.0 ± 4.7 mm, respectively (p < 0.05). Early mortality was 5.5% (6/110). Major shunt-related complications included congestive heart failure (1.8%, 2/110) and acute shunt occlusion (1.8%, 2/110). Median follow-up was 18 months (range 6 to 61), with late mortality of 3.8% (4/104) one month postoperation. CONCLUSION: The central shunt increases oxygen saturation and improves pulmonary artery development effectively with a relatively low incidence of congestive heart failure, acute occlusion, and pulmonary distortion. The adequate postoperation survival, low morbidity and mortality, and less technical difficulty of this procedure make it a more desirable treatment for complex heart diseases.